Mycotoxin Affect On The Gut

Malabsorption Syndrome Due To Mycotoxin Affect On The Gut

The gastrointestinal tract is where swallowed mycotoxins from inhalation or food have their first impact. Whether mycotoxins are absorbed or not, they have an effect on the gastrointestinal tract cells. Those that are absorbed can end up back in the gastrointestinal tract as the liver packs them up in bile to some degree and dumps them in the intestine to be removed form the body. (Unfortunately, they can also get picked back up from the intestinal tract through the interohepatic ciruculation and why binders are used to bind them while in the gut)  Low concentrations are thought by the medical community to not to be important, however they have been shown in research  to effect cell viability. Combinations of mycotoxins have been shown to have additive or even synergistic effects.

Mycotoxins have multiple affects on the gut from negative effects on gut microflora (mycotoxins are strong antibacterials) and irritating the lining, reulting in inflammation and causing leaky gut. The dysbiosis and irritation to the gastrointestinal tract can affect the the digestive metabolic processes. Ultimately mycotoxins can destroy intestinal cells. Additionally, they are absorbed from the digestive tract and after entering the blood stream can end up lodging in various organs and tissues of the body causing a variety of dysfunction, irritation, damage and cell death. Some mycotoxins have been shown in animal research to lower bile levels and pancreatic enzymes. Additionally, stress caused to the body from the mycotoxins as well as feeling of stress in the person from the disease process can both cause increased output of stress hormones which can increase Th2 and lower Th1. Th1 is now not available to help keep viruses and bacteria under control and this allows more dysbiosis in the gut as well as the possibility of viral reoccurrence and bacterial infections in the body. The increase of Th2 causes release of histamine from mast cells as well as other inflammatory substances that can affect the gut in various ways. For example excess histamine can cause inflammation and diarrhea, and excess serotonin can also cause diarrhea. The association with mast cell activation and high histamine is well known by many people who are chronically exposed to mycotoxins. I suggest you read further about histamine intolerance if you are having gut symptoms. Mycotoxins and anything else that causes gut inflammation can alter the enterocytes (intestinal cells) and may decrease diamine oxidase (DAO) production. This means anything that causes intestinal inflammation is a possible factor in histamine intolerance as DAO is necessary to metabolize histamine. Without it  an acquired histamine intolerance will remain for as long as DAO is inadequate. Additionally, when the mycotoxins harm our good gut flora, commensal and pathogenic flora can grow out of control and they can make toxins themselves and activate mast cells to make histamine. Read more about this in one of the many histamine articles I have written.

More on histamine can be found here:

When Food Allergy is Really Histamine Intolerance

Histamine Intolerance: Causes, Symptoms, and Diagnosis

Histamine Intolerance Solutions

Mast Cell Activation and High Histamine

Mast cell mediators can also directly affect the vagus nerve which is a nerve that acts as a modulator of the brain-gut axis along with endocrine and immune links. In addition some mycotoxins are neurotoxins and they may cause vagal nerve inflammation or damage more directly.  Vagal nerve hypofunction is important as this causes a decrease in acetylcholine and will cause a decrease in HCL, digestive enzymes, peristalsis and cause constipation. It causes other issues in the body also, but these are major gastrointestinal effects that are known to many "mold folks".  When you add on the use of  antimicrobials that disrupt the gut or you add binders that slow down digestion, this can become a mess quite quickly and leave an individual confused and dismayed.

There is a lot of research in animals relating to fungus and mycotoxins in food. You might think that research would not relate to mycotoxin inhalation from a water-damaged building, but the fact that inhaled spores, particles of mold and mycotoxins end up mostly in the digestive tract means the inhalation from a moldy building is similar to eating the same mycotoxins in food. Therefore, I present much of the food related research in this article. Many of the same mycotoxins in food are found in moldy buildings too, where they are inhaled, go to the upper respiratory system, are swallowed, and ingested, ending up causing the same issues as mycotoxins eaten in food.

In research with chickens, malabsorption syndrome is a common result of mycotoxicoses. For example, aflatoxins fed to chicks in their diet from hatching until 3 weeks of age (Osborne et al., 1982). In this experiment aflotoxin B1, in levels lower than those needed for growth inhibition produced a malabsorption syndrome characterized by steatorrhea (fat in stool), hypocarotenoidemia (low carotenoids, and decreased concentrations of bile salts and pancreatic enzymes. It is known that mycotoxins cause lipid peroxidation in the body. It is possible that the malabsorption might have been induced by lipid peroxidation in enterocytes (intestinal wall cells).

It is not just fruit, grains, and vegetables that are an issue. Herbs can also have mycotoxins on them as well as meat and milk. Animals will store mycotoxins in their muscles and organs that humans eat. Additionally, mycotoxins are found in the milk of animals that eat moldy food. Animal feed is often moldy when tested. This means meat and milk on the market has mycotoxins in it at various times. People with sensitivity to mold need to be very careful about their food choices. Details on moldy food can be found here.

Additionally, mold sensitive people who are exposed to a water-damaged building will often have an inflammatory gut reaction causing a leaky gut. As a result they may have trouble digesting food and become "sensitive" to many foods. This leads them to erroneously think they have many food allergies, when the actual issue is that their gut is inflamed due to a mold response. Once that is remedied, they are able to eat many of the foods that had previously bothered them.

Some of the symptoms a person with a leaky gut may have are bloating, gas, abnormal bowel movements, undigested food in stools, fatigue, inflammation in other areas of the body and autoimmune conditions such as hashimotos or multiple sclerosis. Brain inflammation due to a leaky gut can cause symptoms such as brain fog, depression, and migraines. Besides a leaky gut leading to immune issues and possibly being involved in autoimmune conditions, some mycotoxins have also been shown to be related to autoimmune conditions.

Mycotoxins can cause weight loss also. The trichothecene mycotoxin called T-2 toxin as well DON induce release of satiety hormones, peptide YY and cholecystokinin which are critical mediators of anorexia.

There are of course other factors besides mycotoxin exposure that can lead to a leaky gut.

Some physiology relating to leaky gut and details on how it occurs.

The intestinal lining is the second fastest reproducing tissue in the body. The whole gut renegerates every 5-6 days.

This means the intestines react to the environment very quickly. 20% of it is renewed each day and reflects that days happenings. Nutrition available and toxins assaulting it will cause an immediate change in 20% of the gut cells each day. The intestinal cells have high nutrient needs. They take nucleotides and amino acids and other nutrients directly from the food arriving as they can only get about 70% of their nutritional requirements from the blood. Without enough nutrients, the gut cells including the tight junctions can not respond optimally.

A leaky gut is caused by damage to the space between the intestinal epithelial cells called tight junctions. Damage to these tight junctions can occur from environmental toxins. Mycotoxins are just one factor that can cause damage.

Many of the mycotoxins, and their metabolites inhibit protein synthesis. It has been demonstrated that rapidly dividing, and activated cells with a high protein turnover (such as immune, intestinal, and liver cells) are predominantly affected by mycotoxins. Since the gastrointestinal tract has a high level of protein synthesis and cellular turnover it is especially susceptible to mycotoxin damage. The tight junctions themselves depend on the proteins occludins, claudins, juntional adhesion molecules and zonula occcludens to function properly. Occludins and the other proteins contribute to the tight junction stabalization and is necessary for optimal barrier function. Zonulin is a protein that modulates the permeability of tight junctions and has been shown to allow trafficking of macromolecules through the tight junctions that should remain in the intestinal lumen. Excess zonulin is used as a biomaker for impaired gut barrier function.

When there is a breakdown in this tight junction barrier, things such as undigested food and toxic chemicals can now get through the gut barrier. They get into the circulation and not only cause damage themselves, but cause the immune system to react to the chemicals/food, which can sometimes lead to the formation of autoantibodies. These autoantibodies then cause a variety of systemic inflammatory responses through-out the body and a variety of symptoms.

Research on animals has shown ingestion of mycotoxin contaminated feed affects the gastrointestinal barrier. In vitro research revealed that mycotoxins increase the permeability of intestinal epithelial cell monolayers. The mycotoxins deoxynivalenol (DON), ochratoxin A (OTA), and patulin (PAT) have all been shown to compromise the intestinal tight junction complex. There is a reduced expression of tight junction proteins, which leads to increased passage of bacteria such as Escherichia coli and leads to malabsorption of nutrients like glucose. (Research article references at the bottom of page.)

Although this article is mostly about environmental mycotoxins, I would additionally mention that it is possible for mold to be in the gut and release mycotoxins into the digestive tract.  Specifically, it appears Aspergillus species that makes aflatoxin and ochratoxin can be found in some peoples guts and they don't get well until this is realized and treated. Candida, which is also a fungus, but a type of yeast rather than a mold, can also make mycotoxins. More research is needed on this matter.

 

Mechanisms that protect the gut and mycotoxin affect on the gut when they are ingested.

Intestinal Health

Intestinal health encompasses passive barriers, and active immunological protection as well as neuroendocrine function. The passive barriers are composed of the protective coat of mucin (mucus coating), gastrointestinal flora, and the tight junction complexes between epithelial cells. The active immunological processes are composed of gut-associated lymphoid tissues (GALT), and intra-epithelial lymphocytes which are part of the immune system. It is important to note that 70-80% of the bodies immune system lies in the gut. The intestines neuroendocrine system is composed of endocrine cells, and nerve elements containing a variety of peptides. Remember, both the tight junctions, the neuroendocrine system peptides, and immune system depend on protein synthesis that is affected by mycotoxins.

Mycotoxins And Inflammatory Bowel Disease

It appears from research that several mycotoxins, when ingested, can lead to similar changes that we see in inflammatory bowel diseases in humans. This inflammation leads to a leaky gut.

 

Low Doses And High Doses Of Mycotoxins May Affect The Digestion Differently

Interestingly, animal research on some mycotoxins has shown a different reaction to low dose mycotoxins, and high dose mycotoxins. When low, or moderate doses of mycotoxins are introduced into the environment of the gut epithelium there is an upregulation of inflammatory cytokines. With high doses of toxins, there is often down-regulation except for IL-6 which was upregulated with high doses of the toxins. With deoxynivalenol (DON) there was almost always upregulation of the cytokines no matter low, or high the dose of mycotoxins.

The point here is that mycotoxins, especially low to moderate doses promote a rapid mucousal inflammatory response, and compromise Th1 and Treg responses over time. It is important to understand that low doses will upregulate the intestinal expression of pro-inflammatory cytokines, especially following DON ingestion. This disturbance in cytokine balance could cause intestinal disorders. For instance, cytokines have a key function in the regulation of tight junction  proteins [Capaldo CT, Nusrat,A, 2009]. These tight junction proteins seal the space between two neighboring cells . However, upregulation of inflammatory cytokines has been related to increased permeability (leaky gut) that could allow the entry of luminal antigens and bacteria normally restricted to the gastrointestinal lumen (gut tube).

Research [Maresca and others, 2008], provides evidence that several mycotoxins induce intestinal alterations that are similar to those observed at the onset and during the progression of inflammatory bowel diseases in humans (among them upregulation of cytokines, increased permeability, and bacteria translocation).

For information on the most common mycotoxins found in the food supply go to the Moldy Food Link.

There is this additional thought amongst practitioners that I will share with you.

In people with CIRS due to water-damaged buildings or mold related illness, they usually have a reduced melanocyte stimulating hormone (MSH). This appears to promote edema in the tight junctions of the gut producing "leaky gut". There is an increase in bile salt production acutely. As excessive bile salts move down in gut they can add to the loosening of tight junctions in jejunum and ileum. However, over time bile flow is slowed in the chronic inflammatory response, and there is a sludging of bile and reflux of bile into stomach and the person can get belching, abdominal pain, and bloating.

I would also add that when the gut is inflamed, the brain is inflamed and vice versa. You usually do not have one without the other.

So, what can be done to help the person with a gut inflamed from mycotoxin irritation, and damge. First the person needs to follow the general protocol for treating CIRS. However, there are some additional things to address.

I mentioned that some people are so sensitive that they are unable to eat hardly anything. These folks usually end up needing to be on a rotation diet where they do not eat the same thing more than once every 4 days, or they react to the food. What is happening is that their gut is so inflamed that everything irritates the digestive tract and the tight junctions are allowing bits of food through them into the body that should not be allowed through. This causes the body to react to the food as an invader and when the food is eaten the body sees it as something to attack. So, the most important thing after removing ones self from the mycotoxins is to address the intestinal inflammation. Diets that are helpful are diets that use rotation of foods and food that is easy on the gut. For folks who have trouble eating everything, they have to go on a roational diet and need to start with eating tiny amounts of things, and building up. Bone/meat broths mentioned below are a good thing for most people to start with as well as fermented foods unless they have SIBO. Many people end up drawn to eating cabbage, which is no surprise since it contains a high amount of glutamine that the gut cells need. There are many different diets used by practitioners and what a person should eat will depend on their situation, and sensitivities. However, I would mention that the GAPS diet is a good place for many folks to start. There are those who will not do as well with it as we are all different. However, many seem to do good as a starting point. Practitioners should help their patients come up with diets that are specific to their individual needs.

Lack Of Normal Digestive Function From Lack Of Digestive Juices

I have noted that many of the people who have "mold illness" end up with digestive difficulties that are often identified as SIBO or small intestinal bowel overgrowth. These people have a lack of bile production and pancreatic enzymes or decreased functionality of the common bile duct or both. They also often have low levels of HCL. THIS SCENARIO IS VERY COMMON IN PEOPLE EXPOSED TO MYCOTOXINS. Obviously, this has to be attended to. Using manipulation of the spine, or using deep tissue work or using replacement enzymes, bile, HCl or all of the above are necessary usually. I actually believe that it is not necessarily just the mycotoxins that cause this. I think the binders used for treatment add to this by slowing the digestive process down.  Additionally, the removal of the mycotoxins which invlolves binders and chelators  can release heavy metals that also ends up causing damage. If it is done too fast, this can cause more damage ultimately.

General Dietary Considerations

Before attending to the food to be eaten, make sure they are making enough HCL, bile, and enzymes or the food will not be digested well not matter what they eat.

Bone/meat broth

Bone/meat broth is a good thing to consume to provide nutrients to heal the gut. In this broth include things like bones with meat and a little fat on them, pig feet, chicken feet. Whole chickens, fish heads are ideas. Not just a bone broth, but include some meat too. Some organ meats are also good. Meat that is muscle meat is the least helpful. Meat close to the bone is great. Add lots of vegetables such as carrots, zucchini, squash, onion, broccoli, cauliflower. Do not use any potatoes or parsnips or other starchy items. Cook long and slow until you have a gelatinous soup.

Use the bone broth along with fermented veggies (Unless you get gas and bloating from fermented veg due to SIBO, in which case this needs to be addressed.) For some of these people who react to fermented vegetables negatively, it is usually a matter of slowly adding tiny amounts of them into the diet and building up slowly.

Meat

Use only meat sources that are from organic or grass fed animals. The grass and hay the animals eat can not be sprayed with chemicals or they will end up in your food, and ultimately in your body. Also remember that animals fed moldy food, provide you with moldy meat, and milk.

Use only organic vegetables.

Use bright colored vegetables and make sure there are foods from the Cruciferae family included such as caabbage, brussel sprouts and kale.

Fats

The person needs to get adequate healthy fats. If the person has issues with digestion of fat (pain, loose stools, floating, greasy stools), light colored stools, gas, consider that they are lacking bile or pancreatic enzymes.  Usually, the first thing I think of with light colored stools and indigestion from fat is to look at liver enzymes and make sure there is no blockage of bile. If the bile is just sluggish, the person needs liver and bile support. I look to the bitter, liver herbs, and if necessary may need to temporarily use a bile salt replacement. Alternatively, or at the same time, pancreatic enzymes may be needed. Sometimes if it is just light stools, and nothing else noted, I will add glycine and taurine to the diet for amino acid conjugation as the liver uses amino acid conjugation to change the bile acids into bile salts.  I find many of these CIRS folks actually need taurine/glycine for bile conjugation. They do much better with fat and their stools take on a normal color after giving it  unless they are so sick that they need bile acid replacement. That is only short term though.

Fresh, Raw Food Or Cooked Food

Fresh, raw food is important in the diet, but may be irritating to some individuals with an inflamed gut. So, introduce when able to.

The gut microbiome should be attended to. How this is done varies from person to person. Consider fermented foods, prebiotics, probiotics, supply necessary nutrients. Communicate with your microbiome about your intentions to bring harmony to the whole system.

Avoid stress.

Use of antiinflammatory and gut healing herbs in tea form is useful.

Herbs To Heal The Intestine

Antiiflammatory, healing herbs are useful.

• Licorice
• Ginger
• Chamomile
• Peppermint

I would caution that these may be to much for these sensitive folks. I have listed the herbs that are less likely to cause a reaction in these folks. People may still react to any of these herbs, but Licorice is the least likely to cause irritation. Realize these folks are reacting to almost everything so all food and herb is a possible irritant. Even those herbs that would usually be healing to other folks may cause a reaction, so the person should be given very tiny amounts to start with and build up. I am talking about a teaspoon at a time for some individuals. For some folks, perhaps even drops the first time. As a practitioner you have to make a decision as to what your patient can tolerate.

Licorice is one that I find is very helpful. Although, there is an issue with contraindications for some people as well as concerns about mycotoxins on licorice root. Besides acting as an exceptional antiinflammatory to the gut, and supporting the liver, it will also help preserve fluid in the body of moldy folks that have trouble with constant loss of body fluid, and low blood pressure due to adrenal fatigue, and/or low anti-diretic hormone.

Marshmallow

Marshmallow is another useful herb that is the anti-inflammatory, antibacterial and is soothing to the gut. Generally, I have people use this in a slurry form, but for these folks I suggest a tea so their gut is not irritated by the fiber. Some people will be bothered by too much fiber, so be aware of this.

Aloe Gel

Aloe is another helpful herb which is generally consumed as organic aloe juice. It is healing to the gut. Do not eat the whole leaf unless you enjoy diarrhea. Only the inside gel should be used. The bitter tasting part inside the outer sheath is a laxative.

Calendula

Calendula is antiinflammatory, antibacterial and healing to the gut while also acting on the liver.

Plantain

Plantain is very healing to the gut.

Turmeric

Turmeric is an antiinflammatory that is used for CIRS in general as it support liver health, decreases inflammation, helps decrease mycotoxin damage and is specific for gut inflammation.

Fermented foods and or probiotics/prebiotics

Fermented foods and or probiotics/prebiotics are helpful even if in minute amounts. "Real" fermented foods are necessary. This means they are raw and not cooked at all. Probiotics are usually given by mouth, but they are sometimes given as an enema if thed probiotics are irritating them by mouth. Additionally, for some individuals a fecal transplant is helpful.

L-Glutamine

L-Glutamine is a helpful supplement for some individuals. It is a fuel source for the epithelial cells in the small intestine, is important for intestinal mucosal integrity, is needed for proper immune function, decreases gut inflammation, and is a precursor of glutathione. It has been demonstrated that glutamine can help improve blood flow in inflamed segments of the colon in patients who have ulcerative colitis, although its benefits did not extend to the most seriously affected portion of the colon. Research shows it increases the number of cells and the villi on these cells as well as reducing permeability of the gut lining. It can be found in grass fed meat, raw dairy products,and in cabbage juice.

Fermented cabbbage is a source of both glutamine and good gut microbes. It contains lactobacillus plantarum which is a very beneficial microbe.

Butyrate

Butyrate has been shown to decrease mucosal inflammation and improve gut oxidative states. Butyrate lowers various inflammatory markers and improves not just gut inflammation but also improves brain inflammation. I would mention that there has been some research refuting some of the positive butyrate data. I have not seen much use of it personally and most people think it stinks to much to want to take it.

Zinc L-carnosine

Zinc L-carnosine may also help decrease the leaky gut by supporting gut mucosal integrity. In animal studies it prevented inflammatory reactions and cellular damage in models of inflammatory bowel disease.

A 2007 study found it reduced small intestinal injury showing a 50% reduction in villus shortening at 40 mg/mml (p<0.01).1

You will find zinc carnosine being used for intestinal permeability (leaky gut) as well as treatment for stomach ulcers.

Essential Fatty Acids are

Essential Fatty Acids are important in maintaining the membrane of all cells in the body. They are therefore in high demand in the intestine where cells turn over quickly. Omega 3 and 6 essential fatty acids have been shown to be helpful in inflammatory gut disease. Omega 3s are the ones I would suggest for people usually as they are less accounted for in the diet. They also help decrease overall inflammation in the body. They can be found in cold-water fish such as salmon, halibut, sardines, trout, or herring.

Sunshine or Vitamin D

Vitamin D mediates the tight junction barriers between the epithelial cells.

The tight junctions between the intestinal cells are mediated by vitamin D, and at the average wintertime levels of vitamin D in North America, these proteins decline, as they do in the entire connective tissue, to the point where for instance, tendon ruptures peak in march of each year.

Sun works much better for vitamin D and is my choice over Vitamin D any day except when not available.

The Gut Microbiome

Normally the gut barrier is protected by biofilms of friendly non-invasive bacteria. These are destroyed by broad spectrum antibiotics, and many mycotoxins act as antibiotics and therefore also kill off our good intestinal flora. They unfortunately have been found to kill off good flora at lower doses of toxin while the commensals and pathgens need higher doses.  Research shows that there is no homeostatic mechanism, with no normal method to restore the previous species or balance once gone. However, some think that our appendix may actually be a resevoir for good flora, although this has not been proven. Simply taking some pills of the "friendly" bacteria may not be enough as the entire bacterial population in the gut, not just the friendly biofilms, is like an additional organ in the body, and it is from this biome that the chemical triggers for tight junctions and gut integrity occur, and these same triggers affect insulin metabolism, and immunity throughout the body, as well as your brain, and mood. In fact, be careful who you get a fecal implant from (If you consider that sort of thing.) Make sure you like their temperment first. The person getting a fecal transplant has been known to take on the mood of the person who donated it.

It is important to note that we use to think taking gut flora replacement would allow those flora to repopulate our colon, but we now believe they are transient in the gut. They help take the place of our usual flora and basically keep house in the area and keep up the activities our normal flora would usually perform. This allows our flora to regrow if they are still there to regrow. If we only take them for a week and stop, that may not be long enough. If we are still under exposure of mycotoxins, we need to keep taking them until we are no longer exposed. Different gut flora have different effects and we have learned that variety of gut flora is the most important thing when replacing them. We have also found that individual species and strains are different and perform different functions. We are just beginning to be able to pick flora for specific actions we seek.

The microbiome also metabolizes otherwise indigestible fibers, including but not limited to cellulose, pectin, inulin, and various polysaccharides. Selective bacterial populations can be increased by giving just one of these fibers which people call prebiotics. Giving a large percent of the diet and a wide array of them (such as may occur in 8-10 servings of fruits and vegetables a day) provides for a healthy volume and a healthy balance in the biome.

If one has been exposed to mycotoxins or is in the process of removing them they usually need to replace gut flora during the process. Once a day replacement with a meal is usually enough and I suggest focuing on ones that do not increase more histamine in the body. I have found that there are some safe ones. I often suggest using a mix of a bifidobacterium such as either  Probiota Bifido from Seeking Health or Probiota HistaminX from Seeking Health. These will compete with bacteria that increase histamine and they help with diarrhea if that is a problem. If constipated something more like Lactobacillus rhamnosus GG (GG is the strain) is one to consider.  A mix of strains that are more normalizing is used if there is a tendency to be constipated or have a slowed digestion and one I like is called Detoxification Support by Klair labs that has both the L. rhamnosus (although not GG strain) and one of the Probiota bifido.

For people who do not have histamine issues they can use a variety of probiotics and using fermented foods can be helpful. This needs to be raw, non-pasteurized fermented products. If you find yourself reacting negatively to taking probiotics or to fermented food products, consider you might have a sensitivity to histamine or be having excess mast cell activation.

Often using probiotics and prebiotics helps our own good flora grow back.  If an indivdiual needs to continue taking gut flora and gets worse when they stop, consider that they may still be exposed to toxins or that they may need to do something else such as a fecal transplant to restore a healthy gut flora.

Research to support tight junction barrier disruption by mycotoxins:

Lambert, D.; Padfield, P.J.; McLaughlin, J.; Cannell, S.; O?Neill, C.A. Ochratoxin A displaces claudins from detergent resistant membrane microdomains. Biochem. Biophys. Res. Commun. 2007, 358, 632–636.

Mahfoud, R.; Maresca, M.; Garmy, N.; Fantini, J. The mycotoxin patulin alters the barrier function of the intestinal epithelium: Mechanism of action of the toxin and protective effects of glutathione. Toxicol. Appl. Pharmacol. 2002, 181, 209–218.

Maresca, M.; Mahfoud, R.; Pfohl-Leszkowicz, A.; Fantini, J. The mycotoxin ochratoxin A alters intestinal barrier and absorption functions but has no effect on chloride secretion. Toxicol. Appl. Pharmacol. 2001, 176, 54–63.

Maresca, M.; Mahfoud, R.; Garmy, N.; Fantini, J. The mycotoxin deoxynivalenol affects nutrient absorption in human intestinal epithelial cells. J. Nutr. 2002, 132, 2723–2731.

McLaughlin, J.; Padfield, P.J.; Burt, J.P.; O?Neill, C.A. Ochratoxin A increases permeability through tight junctions by removal of specific claudin isoforms. Am. J. Physiol. Cell Physiol. 2004, 287, C1412–C1417.

Sergent, T.; Parys, M.; Garsou, S.; Pussemier, L.; Schneider, Y.J.; Larondelle, Y. Deoxynivalenol transport across human intestinal Caco-2 cells and its effects on cellular metabolism at realistic intestinal concentrations. Toxicol. Lett. 2006, 164, 167–176.

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